Karen Harrison tested positive for a mutation in BRCA2, a genetic abnormality that raises her risk for breast and ovarian cancer. She sorted out her options for preventing cancer by consulting experts at the Cancer Therapy & Research Center.
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By Elizabeth Allen

For women whose genes make them vulnerable to certain cancers, radical surgery to remove breasts and reproductive organs can lower their risk and perhaps save their lives. Even so, deciding whether to have preventive surgery is difficult and emotional. Women facing this decision should know that there’s no rush to decide, and that seeking help in weighing their options can help them come to a more comfortable conclusion.

Karen Harrison, 48, knows how overwhelming the choice can be. After she tested positive for a mutation in BRCA2, a genetic abnormality that raises her risk for breast and ovarian cancer, a doctor recommended that she have her breasts, ovaries and fallopian tubes removed.

“I kind of felt a little backed into a corner,” Harrison said. “I just thought, ‘There’s got to be other options out there. Surely not every woman who comes out positive goes through all this.”

That’s when she sought genetic counseling at the Cancer Therapy & Research Center (CTRC) at the UT Health Science Center San Antonio. There, breast cancer specialist Richard Elledge, M.D., and genetic counselor Martha Thomas walked her through her options.

Related links: Who should be referred for genetic testing

Weighing the options
“In general, if there’s no immediate pressing issue — like a recent diagnosis of breast cancer — I urge people to take their time and think about it,” said Dr. Elledge, an oncologist and clinical professor of medicine. “Prevention is never an emergency.”

Richard Elledge, M.D., a medical oncologist and clinical professor in the School of Medicine, treats women with benign and malignant breast disease.

Harrison, who beat breast cancer eight years ago, took the genetic test because she thought the information would be important for her 16-year-old daughter. “I never thought it would come back positive,” Harrison said. “I thought I was through with this.”

Through counseling, Harrison opted to have surgery to remove her reproductive organs but decided against a mastectomy. Removal of the ovaries lowers the risk of subsequent breast cancer by about 60 percent, according to a recent study published in the Journal of the American Medical Association.

After weighing the odds on a recurrence of her breast cancer, she decided they were slim enough that she chose instead to have regular mammograms and possibly MRIs of the breast.

Thomas, who noted that patients often can choose from surgeries and surveillance options, said it’s not uncommon for doctors who do not regularly see high-risk women patients to recommend complete and radical surgery: “To a lot of physicians, if you are at risk for breast cancer, why would you not remove all of your breast tissue?”

But that is a major decision that women should consider carefully, said Dr. Elledge, who recommends that patients also talk to a psychologist before choosing mastectomy.

Study supports preventive surgery as one option to consider
Preventive surgery as an option for women at higher risk for breast and ovarian cancer gained support recently with the publication of a study in the Journal of the American Medical Association. The study focused on women found to have the BRCA1 and BRCA2 genetic mutations between 1974 and 2008. The researchers included Gail Tomlinson, M.D., Ph.D., interim director of the Greehey Children’s Cancer Research Institute at the UT Health Science Center.

Among 247 women who chose risk-reducing mastectomies, no breast cancers were diagnosed as long as the women were followed, which was until 2009. One of 13 women who did not have surgery was diagnosed with breast cancer. Women who had their ovaries and fallopian tubes removed had a lower risk of ovarian cancer and a lower risk of dying from either ovarian or breast cancer.